CMS and AMA Address Physicians’ ICD-10 Concerns

In a welcomed move, the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) announced temporary freeze on certain sanctions and penalties during ICD-10 transition and the availability of additional resources to help physicians get ready for ICD-10.  

Physicians concerned about claim denials associated with incorrect specificity code will welcome CMS’ announcement that for 12 months after ICD-10 implementation Medicare review contractors will not deny claims with unintentionally incorrect ICD-10 specificity diagnosis code as long as the physician/practitioner used a valid code from the right code family. A valid ICD-10 code is still required on all claims starting on October 1, 2015. Medicare contractors are still able to review post payment claims for reasons other than the correct specificity code.

Also welcoming news is CMS’ announcement that sanctions will not be imposed for quality reporting for year 2015. Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes. Similarly, if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes, eligible professionals will not be penalized, stated CMS.

The agency also announced that it will set up a communication and collaboration center for monitoring the implementation of ICD-10. Assisting physicians and other practitioners with the ICD-10 transition will be an ICD-10 Ombudsman whose role will be to receive and triage physician and provider issues. “The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns.”

CMS and AMA will also be offering provider education via webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.

If you have questions about ICD-10, denial of claims, Medicare audits, Medicaid audits, or have other health law related questions, please contact our office.